Hart County ia Hotel/Motel Excise Tax Monthly Report Business Name: _______________________________________________ Business Owner ’s Name: ________________________________________________ Rental Address: ________________________________________________ Business Manager ’s (or Reporter ’s) Name: ______________________________ Address: ________________________________________________ Hotel-Motel Tax Report for Calendar Month of______________________________ ……………………………………………………………………………………………… 1. Gross Rent subject to tax.....................................................$____________________ 2. Tax Due (5% of Line 1)........................................................$____________________ 3. Collector ’pensation (Deductible only on timely returns) (3% of Line 2)........................................................................$____________________ 4. Penalty and Interest (10% of amount due plus interest on the total amount of delinquent taxes at the rate of12% annum)$_________________ 5. TOTAL AMOUNT DUE.......................................................$___________________ ……………………………………………………………………………………………… This return must be filed and paid to the Board missione
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